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HomeMy WebLinkAboutPermit Septic Tank 1974-6-21 or Lr:~ , . ,. ~.:, .. , J'\.~' .:oJ ~~'\"-'; ',' ," LANE COUN'B~I:~G PER:::'- OR MOBILE "BUILDING 0 MH @< MAILING ADDRESS 7080 Thurston Road Hol" USE PERMIT PERMIT NO, (Y1H -:21.../1-'7,9 MM 241-74 I PROPERTY OWNER 'Ollar. Bobby H. CONTRACTOR Same .PROPERTY lOCATION -INCLUDE p':O$T OFFICE Springfield, Oregon PHONE 747-3423 MAILING ADDRESS PHONE 1646 Harbor Drive PROPERTY LEGAL DESCRIPTION - METES, BOUNDS Lot 9 Block 3 FIGbert Grove TWP RANGE SECTION 18 03 02,3;J,- TAX LOT NO. CODE W" 'Vf(J(): ' CENSUS TRACT 35-400 \ ) I APPl. NAME & MAILING ADDRESS FOR MOBILE HOME PERMITS ONLY -No, ,of Bedrooms (3) , Owner EXISTING STRUCTURES ON PROPERTY None LEGAL ACCESS TO PROPERTY Harbor Drive PROPERTY SIZE - FT. ;..,.-.... WIDTH DEPTH AREA' '.. STRUCTURES TO BE BUILT THIS PERMIT Connect to Exi~ting Sewage System D TYPE.CONSTRUCTION SQ. FT. . :;:: aDRMS vv New System [J~ VALUATION Park Moblle~~ome '''". Install Sewage Disposal System (5111 74-603) .. LANE COUNTY SPECIAL PERMiT }\.li,c.:\ ElevatIon: '447 Feet , SEWAGE DISPOSAL . FEES PLUMBING INSTALLED BY OWNER 0 OTHER: NAME WATER SUPPLY' ~~BLlC- H: 0 OTHER PUBLIC 0 BUilDING '. WASTE DISPOSAL PLUMBING PLAN REVIEW PARK TRAILER SEPTlGT,tANK /l)'< OTHERD 25,00 4,00 , 30.00 TOTAL .59.00 ' COUNTY BUILDING & SANITATION SPECIFICATIONS MIN. SEPTIC TANK CAPACITY . WITH 0151. BOX: GAL 900 -DRAIN FIELD REQUIRED 100 UN. FT TRENCH WIDTH FT. ,2 OR SQ. FT. 400 18 Inches of gravel required ,under 'drain tile '"" TYPE OF STRUCTURE r:1H OCCUPANCY I ZONE PUBLIC UTIL. EASEMENT BLDG. $ETBACKSuH. FROM OR. OF ROAD RIGHT OF WAY FRONT 45 SIDE INT. 5 SIDE EXT. AUTHORIZED SIGNATURE - DATE by C, Harbaugh REAR USE ClASSIFICATION 10 foot Public Utility Easement /s/ J.E. Boss John Shook D.ME ' 6-in-]4 slf BLDG. PERMIT - WHITE OFFICE COPY - WHITE COUNTY TAX - PINK PLUMBING - CANARY BUILDING - GREEN SANITATION - GOLDENROD Call 687.4065 to schedule all required inspections. All construe, lion shall comply with Uniform Building Code, D.E.Q, standards IMPORTANT: for subsurface sewage disposal and county regulations covering plumbing. All buildings require a certificate of occupancy before being occupied. (See Details on Reverse Side) FORM = C55-13' (POST THIS PERMIT ON MAIN BLDG. AT SITE) LANE COUNTY, DEPT- OF ENVIRONMENTAL MANAGEMENT c:OURTHOUSE ANNEX. 135 EAST 6th. EUGENE, OREGON 97401 ' ~... ,- - .' ..: ~j} "'-f; - ..' ji.(- T, ",i~1,~~,~~ .," 14 t.::-."~_~ f~,'l' t,PR,OP.ERTY. OWNER it l. '~ii:' ,'~ " . h"j''II1 h~r,:&pbbyll. f" ~'t~Co#tR~tTOR '~"'" " d',s.. , :. >tPROPERTY LOCATION -INCLUDE POST OFFICE ! : 16lla Harbor !)dve ! kPROPERTY lEGAL' DESCRIPTION - METES, BOUNDS . f Lot! Iloek:3 f'1 !bert Grove i_ !; :rwp RANGE SECTION : : I a03 02 3, Z. ,;1 APPl. :;~~;;'::~'E COU~"BUllOIN~ ~::=: j ;r BUILDING 0 MHi [jX MAllINC;-\ADDRESS 70BO Th~~ton Road . M~ILI~q, ,C.fDRESS ~~~,,""" ~-,-- ~ ,,"'" . "~~ '~R MOBilE .HI~ USE PERMIT..... \ PERMIT NO, JIlt 241-74, Spr.'ngfleld. '" , 'PHONE .. , Oregon 7lt7-S423 ,..' Pt-lONE , I , J -;.,.., "'j' ! \ 'i ~ i '1 I,; T AX LOT NO. H': 'Z;'f~ CODE CENSUS TRACT -i..r,' 35-400 .i NAME & ClwrIe r EXISTING'STRUCTURES ON PROPERTY Hone it. .,,- ,1." i ' . ~-J ~ MAILING t:'f- L~~DR~S'S. " :,. :il fOR MOBILEH90E PER(M31)TS ONLY ~, r j No,qfE!t~cJroor:ns . l' ~'"'' '. ?TRUCTURES TO BE BUILT THIS PERMIT : I,f.p,lIrk;~~~"e .~. I :f. h'n$'(atns~fl9G OlspO!lal SystOOl " C:l". ~:~...;/:..{: n'I,- ilr-.f,';f" .,.;i;, >':.;_; - ...f:.. -~~-~:!tLl,\ , . LEGAL ACCESS TO PROPERTY. Harbor DrIve PROPERTY SIZE - FT. ~: ~ _ P.WMBING. ~-'~,.:r.l}\~r;'~ff :'~,;t~i ,'"1 '.'P.l'.,.., ~';\~;P,.ARK~'~lRAIL'E . ~~~'i~~~~;~~J::~~::":':':"'~'''''~~~ ,'~' . t:'(!TOTAL~'_;'';~'~'':''~'< '~~:.if.~b_~"~,~-";: _,.!.-~,~,_' '$ .5~_.()O ~1. J~t~:.:+-~-:;;:~f..~~~\':. ;:t~U;.~:::''-:~._ "COUNTY i:;, ;l:Mft~(~E'pifc.ii:T",t[NK CAFi:'(c:rrt.::?..;"r:'/-' .: ..,' t:t',-l~~~:~J_S;.~-~'~~~' ~~1;~::?'!1'::~-~~i-:-~':"? l~,.{jt(.~ft~~~ll:i7~ul~" l.I~er ~1"i11l:1,HIl! r~;:,- ).~:~':.J ~-'- '{:",;?,:~;,;,'i~ '?~'~ ",~'y;::::,,:.._ L~;~..._,;_ t" . ',,,14' 1li;~t!l'''k<'~g'i'(:\''!..'' "'\ \ t':. :";~:':-:~:.~)~.;~:~X:~j:~-ii'{,~>{~.~ '-l " 'l:r,';:~'"~Z'''"'(:''''' . i'~Sr:;1,.~,a:..~,-' '" '~lIT!i'PE'bF.estRl1(TURE~~'~~\ " ['~,J~y~IH'[~,.~tX~~?:~:: .~" . ~j: _? '~ALD? ,:sF~1v~_~s~'C":!.rT_:'~.FRq~;~CT~': OF)ROAD' RIGHT OF WAY ; ;j,RON~"( '45,'~;;i6i!INLS, SID' 'XL ~' _:.p,-~ _",: -- ,I;,:'" j, ~~. '_;_,,;~fi~ ','''' ~AUIHORIZED', SIGNATURE - DATE r ijl~f.,l.~.~_Qlii""':W'e. ,iji!lrbauSlh , ::1"1':" " ',." , ., ;ii tBLp-9. _PERMIT,~:,!,!HIT~ :',i;:.OF,~f(Ec'OP.y'.:..:'YJHITE , ..~ c}l".G"O,tJNTY"TAX '::..)'INk":_' :l/' ~~f\:, ,PLOMBI~C;~CANARY',":'; ~. -BUIL:D'I'~G'7__GREEr'(',_ ,,':, ,', ~'~j"'" '~AN)tAT(~r:,r '~'GbLDENROD ;~~; /"" ';' '. :1'if )'f"l" ~ ,', , '. . . ',' , ",;;J," ',,_,-,,<'w_ ~lSf~."R",..~"'~,;,-'i::g..~l',',",,,'.\,l~~,.,,_, ,.", ' , ",,' ,~...'...., ,",_'.... ',~u-':t,~:": '__,.L__.~-.;' l!5.9Y ;~.eo I. r ,Ii,',~:,: -'_'i<(' Connect to Existing' Sewage System D 't":~N~,w," ';S~s't~_n.J'~~~~.~ , TYP~ CONSTRUCTION SQ. FT. :;; BDRMS YALUATIO.N;,.cI1~4_; , '."I'P ,_,~ ~ -~}~.' If . . ,"', I >~ .-~,-f:-. (SIN 74-603) LANF. rOIlNTY SPECIAL PER~:f~~;!A~;~~,.;~ EI..,atlun: 447 Feet , :". ':i';ii~. ,;~ ';;j"ff'~^ I 7-:. '~ '-, ,"t.--..) ;>-."j-"''',', ','S J" / i' . '" ';.;:r ',;,-_;/ \,. . ,.f:::,<:..l , "",,;, """ , I'; "",~";~~::;'~--:'-,. '-. ,.-,,~,~ ", .~\i'€'q ~i ::':I~-ti.~~~-'~,: . J.., .':, ~\~~ .'.. ':'-' "'\" ","~~'f;'.,~..~,~. :-'~~n, ,_'J " 'JI .:r~-,ri :,~~(. 'i., . ' .f.' ~r;;1 -~~ . "~_-\' . '.. ;(h~J';'i\" , , -\.I;, ',." ' r \, ,~~ ':-~~ ~\t<ll'I.s~ '; .1")" _:.:>>;:,-'.:J:.i:f;.~,;:~~~.f~';If1":' '~1: '" ,- ;,~~OD . l.1"" OR sci FT' j':,:"J'f' . '" %1 'f ": , " " ..' . '\9;'~~";~""1 J' ,.....-' ..>.~~ .1{;?:,":' /~:.~,.,it"f..t~~' .. '- ~'--'J'__..- """';!f'-'!"~ -'"", \~';":;)<;-1~.~}t~:~W~ '"-'''-''~'~111..M:rt}ilf~':;''' -&r'?-,., _,~ .., ' " """'l-""~F'" "'';'.~,r ,or.:;",; .~.-, ,:'-~. ,1...;, ":"!ri"t'!It~~l;i;";,;~' .... '~':f<' ,Z~~'\ 'ii;:f~~[~~i~~~[l;;~,;~t:>;{I.:r USE ,CLASSIFICATlON- ~-:::~- ~~-<. .~.~.~~.:,:-.(-,~"_ .!i,~':?' 'l.~' '~'.'/,';~~:-:, to l'l'lOt Plibllc Utlllty~i.~[ft;P;;;;;~'{i'~ "4,~') '~-' ' ;;, - -. ", .' -<-, ';,..,i~o.:{:7',~i'ail, ~- ,+~lIi;"" ':{~Jr-" : :,:,~J- Call 687-4065. to sche~u-'e-all "re.q,uired ins'pectiOri~;;:jAJI. cd6~~t&,c:?r 1-:--' ,", tion sholl comply, with.. UhiforT.)3uili!ing Code, D,E,Q. st61):ilo,as~ ,/ IMPORT~~T; ';for su~surfoce se:-v,:g~ diSeO~.oL'o',n"d','~<>;unty, re,gu..la.,~io..h.. s. '.C,',o,>~~...,.'~j.~:?, ""'. )~I~mbmg. ~II. bu,ldJng~ . r~qulre"'a~ertlflcate of occu~.~,c!-~~~f;t~ .-t.~, being, occupied,,"', ' .' ".' .~,.., ,', ., "I ; , ,~;_' \ (See Details ~h, Revers,e.S,jct~}:...; A-, "<~'~1~:;~l,,~ " ~, :~ ' 'I (POST THIS I'ERM!T'" ON MAIN BLOG, AT SITE) , , ! LANE COW~rY, DfPT;,,:Of ENVIRONMENTAL MANAGEMENT ;. COURTHOUSE AN~E~i,13.5 EAST 6th,EUG.ENE, OREGON 97401 WIDTH DEPTH AREA PLUMBING INSTALLED BY '''X EJ FEES OV;..'NER ',[] OTHE'R; N'AME WATER',SUPPLY PUBUC":~'( " ';~ D '''OTHER bTHERD i: " "'O~fiIe .. - \"f~~': '.,";', "'l- BUllDJl',iG. &SAt,HTATlON..SPECIFICA TIONS DRAlN1FIElD-_REQUIRED < UN, ,F~~",,-~,:'~lOb TRENCH WIDTH FT. .' 2 ,- ' l '~ \ , , , . ... ,:!I.:>: ,,' ',1:..~1:~\' .~ " .~,. ~ :,OCCUPANCY . ,,_j~._t.1' ';'C,: ";:i: ' 'It,., , '~__;-'REAR JQh~Shoo~ ' '~; . < ,;;'.:",-~i:i..i;..:~,S,i;;,~w~',:-, ,< ~ '_:. . '" ,- -~; ,Lj ,. , SITE INSPECTION ApPROVED Cl DISAPPROVED Cl DATE REMARKS FOUNDATION INSPECTION ApPROVEO L...,,! DISAPPROVED L...,,! DATE REMARKS FR~MING INSPECTION ApPROVED / / DISAPPROVED /7 DATE REMARKS LATH OR SHEETROCK INSPECTION ApPROVEO L...,,! 01 SAPPROVED ~ DATE REMARK S FINAL INSPECTION ApPROVED ~ O..ISA~PROVED ,~'fhl DATE Pf II '-f/J r Ji1t:l 1- Ft - "I if R~MARKS " CERTIFICATE OF OCCUPANCY READY TO ISSUE / / NOT READY TO I SS~E /7 DATE REMARK 5 fiR J.1/I-7/( j~ I~tf~ I , -, INSPECTOR INSPECTOR I NSPE'CTOR INSPECTOR INSPECTOR ....- ~ I~fl INSPECTOR JI~J}~ " V" ,", ".;'; ~I.I rJ - ~t :-~-.. ..-:.... - -, ....- 1 - - . ~ -- .. .0-..... .. PROPERTY OWNER . ;:- iFI tt-J I LANE COUN~BUILDING PERMIT OR MOBILE HO E BUILDING 0 MH Q)Jl i- MAILING -ADDRESS 10aO/Thldl'Ston ~&d MAILING ADDRESS_ USE PERMIT PERMIT NO, 'J \ 1\ f . " I I ! Oller, OctIby >>. CONTRACTOR tic...."...". PROPERTY LOCATION - INClUDE POST OFFICE SprIngfield, Oreson t1M llt)'.71} PHONE 7fl7-342S PHONE . .,,', .."'1 ,~ MerborOrlve, PROPERTY LEGAL DESCRIPTION - METES, BOUNDS Lot 9 Bleck 3 FIBbort Grovo TWP RANGE SECTION ~ IS O~ 02 ? TAX.LO:r NO:/'Qr} fT &.' r "'{,... CODE CENSUS TRACT 35-1:00 NAME ~r EXISTING STRUCTURES ON PROPERTY NaItO LEGAL ACCESS TO PROPERTY HDrbor DrIve PROPERTY SIZE - FT. '., APPL. & .MAllING ADDRESS WIDTH DEPTH AREA FOR MOBILE HOME PERMiTS ONLY No, of Bedrooms (D) STRUCTURES TO BE BUILT THIS PERMIT Connect to Existing Sewage System 0 New System ~1t . TYPE CONSTRUCTION SQ. FT. . :;: BDRMS VALUATION Portt 1'lo!>1.lo h= I:notoll SOJD!lO Dlsposol SY8tG::l ARl!.l\ (SIl114-Go~ COUN'!'V ~PEClAL PER'Ml"f ' " ElovatlOQl: 447 Foot SEWAGE DISPOSAL . FEES PLUMBING INSTALLED BY OWNER 0 OTHER: NAME WATER SUPPLY PUBLIC B':(' 0 OTHER PUBLIC 0 BUILDING WASTE DISPOSAL PLUMBING PLAN REVIEW PARK TRAILER SEPTlC..TANK 0)( OTHERD 25.00 4.6:1 30.00 MIN. SEPTIC TANK CAPACITY WITH DIST, BOX, GAL. SllO . 59.00 COUNTY BUILDING & SANITATION DRAIN fiElD REQUIRED 100 SPECIFICATIONS TOTAL lIN. FT TRENCH WIDTH fT. 2 OR SQ. FT. 4c3 IG Inehos of fjrOV0' required umlcr drain {llle '. TYPE OF STRUCTURE r.M OCCUPANCY I ZONE PUBLIC UTIl. EASEMENT FRONT BLDG. SETBACKS __ FT. fROM CTR. Of ROAD RIGHT OF WAY 4s SIDE INT. 5 slOe EXT. AUTHORIZED SIGNATURE - DATE Isl J, E. Boos I>y c. Horbcueh ~ REAR \ USE CLASSIFICATION 10 feet Pu~l'c UtIlity ~ogc~nt Jehn S,,~ DATE' .', C-l!la1~ \3,Qv ' BLDG. PERMIT - WHITE OffICE COPY - WHITE COUNTY TAX - PINK PLUMBING - CANARY BUILDING - GREEN SANITATION - GOLDENROD \, ColI,687-4065 to schedule 011 required inspections. All construc- tion sholl comply with Uniform Building Code, D,E.Q, standards IMPORTANT: for subsurface sewage disposal and county regu'lations covering plumbing. All buildings require a certificate of occupancy before being occupied. (See Details on Reverse Side) \ FORM:: C55- 13 (POST THIS PERMIT ON MAIN BLDG, AT SITE) LANE COUNTY, DEPT, OF ENVIRONMENTAL MANAGEMENT COURTHOUSE ANNEX, 135 EAST 6th. EUGENE, OREGON 97401 I SLAB FLOOR 'PLUMB' NG GROUNCMORK ApPROVED / ,/ .DlfsA'PPROVED Cl DATE I I, , REMARKS GAS PIPING GRpUNCMORK ApPROVED / / DISAPPROVED ;---y DATE REMARK 5 " ROUGH PLUMBING ApPROVED / / DISAPPROVED Cl DATE ", REMARKS I'. ROUGH GAS PIPING ApPROVED Cl 01 SAPPROVEO Cl DATE' REMARKS FINAL PLUMBING ApPROVED W' REMARKS ! ! DATE~ti:-;7~ 01 SAPPROVED I' FINAL GAS PIPING ApPROVED Cl DISAPPROVED ;---y DATE REMARK 5 CERTIFICATE OF OCCUPANCY READY TO IS.SUE Cl NOT READY TO ISSUE';---Y DATE REMARKS I : INSPECTOR INSPECTOR INSPECTOR f " INSPECTOR INSPECTOR~~~ U INSPECTOR INSPECTOR . , " r.. ,', " " , - .~'~. . , I NSTAttER: ~ 'C'omp.1 ete top :~~; ",., ", '~ROPqSED p~~t of for!!! '. ~" "~'1 .... . , . ..' \.~ ,SEWAGE D,isPOSAl SYSTE'M REtORD',.',,': ,-":'~~,~,~ ,. So ,si,gna'~!lreand submit- both,c<;>p; '",ith -appl ication.." " , "'. 'PERMIT NO.MH241-74.' ;~O:,ERn A()()RE~~74 -l,a3", ,JS "'+646 HARBOR DR. .. c 'Bas,ementi. ,Water Supp I,y ~ , \'es" ~ (Npi Pub Ii c ~ ,Other~L ist ' 'INSTALLER'S Ntll1E' ?,'....', ',' ',,'~ {)~,;r1/d;ry{l.iJ~~,~,:~"~ No. Li,ving Units,' Bedrooms ,,',BjHhs ,?" ',I ,Septic Tank:' ',:, Ft'. from well . Steel c;.d.~/Y(I ;;4?;;l,,:/;;, I ris'i de D',mens ions':' Ft. 'Len9th, Width' Diameter OWNER 'NAI1E~ "5PR INGF I ~~D) 0/' 9~~7? ',le~gth of Liries-Ft;.; , "1 T~en<::~'1 Total S~: I/9U2, .3, 4, 5",6. W,dtW"..Ft.4v p 'lot Plan, (see instructions)':, MAllol NG ADDRESS "2': ,~ ,~. ~ \, ''''' " '9",- . ;' . .... ~ . . .,,-. ". < - " ~ '" ~ "t- ,D'~',"Concr.ete:'IXI,N:: Compartments 'x .:,Gal'fa~~c:ty Ti Ie Disposal Field:".'" Distribution Box:" Yes.",.... :, No Other !listribuHon-Type ',,'.. ,', {oDe' " Deetii " ' 'BOBBY H . OLLAR ':; -:::7080 TH~R~TONRD~ feet from, ,? ,# '. WEll (t..-VA_~;.t ' tJ~;;:;Fou~dat ion '7'11.<1~/V~~..e. Lot' li ne ,'; ':r7 " front '/../1 :t{,,~ ' :.'S id'e-' II E',&. ' Rear' f. (J,p, I Ft. Betwee~:" IFi1Jelf,.~lfi!lerDePth \Filler"Below, ", , lines q " .Typelt-2~bove TileAinJrile/,9in, ' i- ,'.- " ',' . .... .> , , -,.. "'. " -'. ..- ,... .. .....: . , " . .-" , , :\~-, '\: I 1 , , , " . .., , '-r.J{';' , , ; -+ ~ :,' ", .'. i ;.~.; .: ." " " '"-, , 'J' " ,', ,0, ~ '\_, 'V' "I,G,',,',' '" .~. '.' -~-,;.q' .... ,\("':,', '7( ',,', ,7lo' ''- d,,,, " ~ ,d1J'C; 1 ::. " <9:' ,> 0:1.. " " 'd p, ~:l:: ";-f-),'1:' "~,' ". l ,'.'.., \ ~. .' '\ , " ," . ..~.. , /,' .., '-,'." " .', " . ~."',.. .-' .><-/ ..' '"",.!;/ :/ .~ ~ ""'--'-,I ~ : -~'.' . '"-' -.. ," ,.; .'~ -..!.'~ -.', , ! "-'~-'-~ . . .' : ',' '('-, /,/".2' ~: "'-;t ,/"" : ~ Date 'Ck;"~i; ,'J 5: la/7JL S i 9nature ...t~ (tlLtd". For ',Sal)it<i;i,an ,Use Only:' '. ~E~:IFICA~EDF SAT;IS~ACTOR~;CO~.P\ETION ", . Date'; bja.s(7r' ,In :ac~ordance wi-th 1973 Oregon 'Laws Chapter 835.' Section 214}his certificate is' i'ssued'" ' ' "as' evidence of sat[sfac~ory ,completion of. a sU,bsurface sewage,disposal system at ,the above location. """" " , ' , , : !AI. Approved: System I nstallllt i on conforms to current standards . , D' Disapproved: ',Do\!s 'not conform 'to current standard's Rema'fks: , > , C55-11 ";" , . . .... '. -',,-- , , '..: 'cl~\(\j.;2 . ',"s n tari~gnaf~re ,l COUNTY'. " ENVIRo.~I1ENTAl QUALITY .J" . .... --,- " " ',' " STATE',OF' OREGON, DEPARTI1ENTOF >, f _ . " 'LANE 'COUNTY ~DING PERMIT OR MOBilE: H~M~E, APPLICATION , PERMIT TYPE,-- BUILDING D' MOBILE HOIv\E>\{~5CREG# " PERMIT #17!/~f)y/-7lj PROPERTY OWNER MAILING AD~S ~ . A //() PHONE 1]ghiJ'v N. '()J.il,4.(( ?o9:n fl1/A!?STa,U ll;;,':g~<:'Y.. -')4'7-39'::23 CONTR~ MAILING ADDRESS ./ tf/ / PHONE PROPERTY LOCATION -'INCLUDE' POST,OFFICE J 64 (,- fI,4 R AI) vD; J v€. PRO,PERTY LEGAL DESCRIPTIO;;', C' 4/" ;r-':/.', ~ LOT - BLOCK- - SUBDIV. . :r:...A-e4.~ .~~ Tj' 5( RAN~E 3~;C. ;;L' TAX LOT #i APPLICANT 13~L4 (0' tJ!LvL, NAME . 7 010 jp,~ iV, MAILING ADDRESS ~0I\"l5l~'. FOR MOBILE' HOM&'P,ERMIT ONLY, "Number 9f Bedr.ooms - STRUCTUR.ES TO BE BUilT THIS PERMIT ;r::-/-' c , ' 'I /J-d, 3> METES & BOUNDS 0 YES ATTACHED D .NO AND CENSUS TRA(T ,5)"> L/OC! DESCRIBE EXISTING STRUC-TURES ON PROPERTY. IF ANY '/0),A/ e- LEGAL ACCESS TO PROPERTY - ROAD NAME OR # ;I Q/I)'r&-1,. f)~ PROPERTY SIZE-WIDTH CODE. hI? DEPTH //~- AREA. / .3 _. Connect to Existing Sewage System 0 LJI.NltE. CO~STRUCT,IO~ ' SQ. FT. " COTT1.Trnh ~' ';\1.[ SF ' , " ..' , '/ECIAr-p , , " ,,' 11:.01 .......LV , / 'L- or New $ystem Rl?q_~ , # B-EDROOMS VALUATION " / /: ,TAREi! " if~ ~J~ ~~ S~!)S SEWAGE DISPOSAL SJ' - 7 Lf'; (, c> ::5 SEPTIC TANK ,0 OTHER 0 F~ES WATER SUPPLY PUBLIC 0 ", BLDG. $ &J.): 00 . 4, 0'6 PUBLIC ~' rLUMBING FEES FACILITY .PE~_d~-.;.fI YES 0 NO~'~;;) DATE 0?/7Y DATE 6/ r/'77 " WASTE DIS. PLUMBING PLAN REVIEW - =-----, FIXTURES PAR~ TRLR. -:3';,00 TOTAL 'O-1.OD MIN. SEPTIC TANK CAPACITY Lf..{)O WITH' DIST. BOX, GAL. cJ V'CI, 1..' t"/Q , TY~E OF STRUCTURM If OCCUiANCY BLDG. SETBACKS - FT.'F.RO.M CTR. OF ROAD RIGHT. OF' WAY . ZONE REAR YARD-' PUBLIC UTIL. EASEMEN! Dofe USE CLASSIFICATION REAR 10 I Pile, ~' j)/J BLDG, INSP'lYJ " :I{ ~ -/9- ?;. I "/ . FRONT <y r SIDE INT, r S\~\~kQ'?A71it p~/ ~Jclions 10 Find Property:': ,', ,', . SIDE' EXT. ~ -/~-::Y COPY 1 - OFFICE COPY 2 - JOURNAL COpy 3 - AUDIT .. Form:#: C55-12. v . . '( ) ( ) ( ) Building Permit Appl ication No. Site Inspection ~ Pre-Permit Investigation JS/cH ,H1I-21/J-7V T ~~7.Q:iS 07, TAX LOT CE'NsD"fRACT ," r- Yb~,...r 6-rJJlte- / APPt.'ICANT: . " L-.Df g.. 3, NAME Ollar ,/ ' '. ADDRESS / / ./' ("-/~-::'7Y / B!.fILDING SITE EVALUATION . , -, PHONE DATE Zoning Ordinance Compl iance , (Zone~~-MM Subdivision Ordinance ompl iance NOT aDD I i cab I e () ( ) ( ) ( ) ( ) ( ) NO YES NAME DATE PLANNING DIVISION 1. ( Required Access' ( ) ( ) '( ) , ( ) , 2. 3, ) G ) I ( ) ~%~' h -/Y-7'1 4. Bui Iding Site, (Area, Wi'dth,. Frontage, Setback) 5, ,Other (see comments) COMMENTS: 6. Plans Submitted NOT NO ~ES appl icable - , (.) () NAME DATE BUILDING INSPECTION DIVISION Flood Plain 0) ( ) ()> /D/J r' ~"~j,I;/~~ ( /,1../'- ~ , 7" Soil Stabil ity (footings) 8, 9, Other (see Comm~nts) COMMENTS: WATER POLUTION CONTROL NOT NO YES ~fiQ DATE aDP I icab I e (0' ~6/~ 10, Sewage Disposal ( ) ( ) 11. Us ab 1 e Area ( ) ( ) ( ) \J " 12. Water Supply ( ) ( ) ( ) 13. Other (see Comments) ( ) C ) ( ) COMMENTS: TO APPLI CANT: ( ) () ( ) Building Permit / Site Inspection: Can be approved, Cannot be approved at this time as ind;'cated on item NO. above. Quest ions and further informat ion on i.tems I through 5 contact the Lane- COUNTY PLANNING DEPARTMENT. Questions and further information on items 6 through 13 contact the Lane County Buildinq and Sanitation Division. Will be held in this office until you can resolve the problems indicated, Is bein~ returned, ' Your ~uilding permit' appl'ication fee is being returned under separate cover." , Your 7.P r...x' b" '7~fo) e~ DEPARTMENT OF ENVIRONMENTAL MANAGEMENT 135 Sixth Avenue East Eugene Oregon 97401 PHONE: 687-4065 LANE COUNTY PLANN'ING DIVISION PHONE: 6,87-4186 C55-28